Cancer in the Elderly
Biology, Prevention, and Treatment
Summary of Key Points
Epidemiology of Aging and Cancer
• The older population continues to expand as a result of reduced mortality and birth rates. Currently 60% of all malignancies occur in persons aged 65 years and older, and this proportion is expected to rise to 70% by the year 2030. Although cancer-related mortality is declining among younger persons, it is increasing among the oldest persons.
• It is of special interest that cancer appears to affect mainly older persons who are otherwise healthy and would have lived longer were it not for the cancer.
Aging and Carcinogenesis
• Carcinogenesis is a time-consuming process, the end-product of which—cancer—is more likely to develop at an advanced age.
• Aging is associated with molecular changes that mimic carcinogenesis; older cells are primed to the effects of environmental carcinogens.
• Aging is associated with environmental phenomena such as immune senescence or proliferative senescence that favor the development of cancer.
Aging and Cancer Biology
• The biology of the tumor cells (e.g., the prevalence of multidrug resistance protein 1 in acute myeloid leukemia increases after age 60 years, causing a worse prognosis).
• The aging of the patient: an age-related increase in circulating concentrations of interleukin-6 (IL-6) may favor the growth of lymphomas, whereas hormonal senescence may inhibit the growth of breast cancer.
Assessment of the Older Person
• Aging involves a progressive shortening of life expectancy and reduction in the functional reserve of multiple organ systems.
• Personal and social resources to cope with stress may become more limited.
• Reduced life expectancy and reduced stress tolerance lessen the benefits and enhance the risks of medical intervention.
